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| Bruxism / Tooth Grinding |
Bruxism (from the Greek βρυγμός "gnashing of
teeth") is characterized by the grinding of the teeth and
is typically accompanied by the clenching of the jaw.
It is an oral para-functional activity that occurs in most
humans at some time in their lives.
In most people, bruxism is mild enough not to be a
health problem. While bruxism may be a diurnal
(during the day) or nocturnal (during the night) activity,
it is bruxism during sleep that causes the majority of
health issues and can even occur during short naps.
Bruxism is one of the most common sleep disorders.
teeth") is characterized by the grinding of the teeth and
is typically accompanied by the clenching of the jaw.
It is an oral para-functional activity that occurs in most
humans at some time in their lives.
In most people, bruxism is mild enough not to be a
health problem. While bruxism may be a diurnal
(during the day) or nocturnal (during the night) activity,
it is bruxism during sleep that causes the majority of
health issues and can even occur during short naps.
Bruxism is one of the most common sleep disorders.
| Photo of Bruxism-related Tooth Damage |
Causes
Bruxism is more accurately classified as a habit.
Some bruxism activity is rhythmic (like chewing) though
some activity is sustained (clenching). Researchers
classify bruxism as "a habitual behaviour and a sleep
disorder".
Most bruxists are not aware of their bruxism and only 5%
go on to develop symptoms, such as jaw pain and
headaches, which will require treatment. In many cases, a
sleeping partner / parent will notice the bruxism before the
person experiencing the problem becomes aware of it.
Bruxism can result in abnormal wear patterns of the biting
surfaces of the teeth, abfractions and fractures in the
teeth. This type of damage is categorised as a sign of
occlusal trauma.
Over time, dental damage will usually occur. Bruxism is
the leading cause of occlusal trauma and a significant
cause of tooth loss and gum recession.
In a typical case, the canines and incisors of the opposing
jaws are moved against each other laterally, i.e. with a
side-to-side action, by the chewing muscles that lie on the
inside of the jaw joints (medial pterygoid muscles). This
movement abrades tooth structure and can lead to the
wearing down of the biting (incisal) edges of the teeth.
People with bruxism may also grind their back (posterior)
teeth, which will wear down the cusps of the biting surface
of the teeth.
Bruxism can be loud enough to wake a sleeping partner.
Some individuals will clench the jaw without significant
lateral movements. Teeth hollowed by previous decay
(caries) or dental drilling, may collapse, as the cyclic
pressure exerted by bruxism is extremely taxing on the
tooth structure.
Bruxism is more accurately classified as a habit.
Some bruxism activity is rhythmic (like chewing) though
some activity is sustained (clenching). Researchers
classify bruxism as "a habitual behaviour and a sleep
disorder".
Most bruxists are not aware of their bruxism and only 5%
go on to develop symptoms, such as jaw pain and
headaches, which will require treatment. In many cases, a
sleeping partner / parent will notice the bruxism before the
person experiencing the problem becomes aware of it.
Bruxism can result in abnormal wear patterns of the biting
surfaces of the teeth, abfractions and fractures in the
teeth. This type of damage is categorised as a sign of
occlusal trauma.
Over time, dental damage will usually occur. Bruxism is
the leading cause of occlusal trauma and a significant
cause of tooth loss and gum recession.
In a typical case, the canines and incisors of the opposing
jaws are moved against each other laterally, i.e. with a
side-to-side action, by the chewing muscles that lie on the
inside of the jaw joints (medial pterygoid muscles). This
movement abrades tooth structure and can lead to the
wearing down of the biting (incisal) edges of the teeth.
People with bruxism may also grind their back (posterior)
teeth, which will wear down the cusps of the biting surface
of the teeth.
Bruxism can be loud enough to wake a sleeping partner.
Some individuals will clench the jaw without significant
lateral movements. Teeth hollowed by previous decay
(caries) or dental drilling, may collapse, as the cyclic
pressure exerted by bruxism is extremely taxing on the
tooth structure.
Symptoms
Patients may present with a variety of symptoms, including:
Associated Factors
The following factors are associated with bruxism:
Treatment
Bruxism may be reduced or even eliminated when the
associated factors, e.g., sleep disorders, are treated
successfully.
Although there is no single accepted cure for bruxism,
there are a number of treatments available.
Mouthguards & Splints
Ongoing management of bruxism is based on minimising
the abrasion of tooth surfaces by the wearing of an acrylic
/ soft plastic dental guard or splint (Bite Raising
Appliances, BRA’s), designed to the shape of an
individual's upper or lower teeth. These are made by
dentists.
BRA’s are thought to work in the following ways:
A BRA is typically worn on a long-term basis every night.
Although BRA’s are a first response to bruxism, they do
not in fact help cure it. Professional treatment is
recommended to ensure proper fit, make ongoing
adjustments as needed and check that the occlusion (bite)
has remained stable. Monitoring of the BRA is suggested
at each dental visit.
Another type of device sometimes given to a bruxist is a
repositioning splint.
A repositioning splint may look similar to a traditional BRA
but is designed to change the bite (occlusion) of the
patient. Scientific studies of these devices generally
showed no benefit over more conservative therapies.
Useful Articles:
Cochrane Database of Systematic Reviews 2007.
Occlusal splints for treating sleep bruxism (tooth grinding).
Medscape Medical News
Patients may present with a variety of symptoms, including:
- Anxiety, stress and tension
- Depression
- Earache
- Eating disorders
- Headache
- Insomnia
- Sore / painful jaw
Associated Factors
The following factors are associated with bruxism:
- High levels of anxiety, stress, work-related stress,
irregular work shifts, stressful profession and
ineffective coping strategies - Relatively high levels of consumption of caffeinated
drinks and foods, such as coffee, colas, and chocolate - High levels of blood alcohol
- Smoking
- Disturbed sleep patterns and other sleep disorders
(obstructive sleep apnea, hypopnea, snoring,
moderate daytime sleepiness) - Malocclusion, in which the upper and lower teeth
occlude in a disharmonic way, e.g., through premature
contact of back teeth - Drug use, such as the newer antidepressants (SSRI’s)
and stimulants (such as ecstasy, MDA and
amphetamines) - Hypersensitivity of the dopamine receptors in the brain
- GHB and similar drugs when taken with high frequency
- Disorders such as Huntington's and Parkinson's
diseases - Obsessive Compulsive Disorder
Treatment
Bruxism may be reduced or even eliminated when the
associated factors, e.g., sleep disorders, are treated
successfully.
Although there is no single accepted cure for bruxism,
there are a number of treatments available.
- Mouthguards & Splints
- Habit Breakers
- Nociceptive Trigeminal Inhibitor
- Biofeedback
- Cognitive Behavioural Therapy
- Botox
- Dietary Supplements
Mouthguards & Splints
Ongoing management of bruxism is based on minimising
the abrasion of tooth surfaces by the wearing of an acrylic
/ soft plastic dental guard or splint (Bite Raising
Appliances, BRA’s), designed to the shape of an
individual's upper or lower teeth. These are made by
dentists.
BRA’s are thought to work in the following ways:
- constraining bruxism so that damage to the TMJ joints
is prevented - stabilisation of the occlusion by minimising the gradual
changes to the positions of the teeth that typically
occur with bruxism - prevention of tooth damage and
- assist a dentist to judge - in broad terms - the extent
and patterns of bruxism through examination of the
physical indentations on the surface of the splint.
A BRA is typically worn on a long-term basis every night.
Although BRA’s are a first response to bruxism, they do
not in fact help cure it. Professional treatment is
recommended to ensure proper fit, make ongoing
adjustments as needed and check that the occlusion (bite)
has remained stable. Monitoring of the BRA is suggested
at each dental visit.
Another type of device sometimes given to a bruxist is a
repositioning splint.
A repositioning splint may look similar to a traditional BRA
but is designed to change the bite (occlusion) of the
patient. Scientific studies of these devices generally
showed no benefit over more conservative therapies.
Useful Articles:
Cochrane Database of Systematic Reviews 2007.
Occlusal splints for treating sleep bruxism (tooth grinding).
Medscape Medical News
Habit Breakers
This is a development of a BRA's. These are worn mainly
at night. When the patient clenches, the metal 'projections'
impinge on the roof of the mouth. This would wake or
disturb the sleep of the clencher and would theorectically
break the habit (eventually).
This is a development of a BRA's. These are worn mainly
at night. When the patient clenches, the metal 'projections'
impinge on the roof of the mouth. This would wake or
disturb the sleep of the clencher and would theorectically
break the habit (eventually).
| Photos of Mouth Guards / Splints / BRA's |
Nociceptive Trigeminal Inhibitor Device / Appliance
The NTI appliance fits on top of the teeth and alters the
angle at which the jaw opens, by covering only the front
teeth and preventing the molars from coming into contact
with each other, thus limiting the contraction of the
temporalis muscle. When the grinding starts in the night,
the pressure which is applied to the incisors can, it is
claimed, send an alarm signal to the brain.
The NTI device must be fitted by a dentist.
The efficacy of such devices is debated. Some writers
propose that irreversible complications can result from the
long-term use of mouthguards and repositioning splints.
Useful Articles:
Evidence Based Dentistry 2009. The NTI-tss device may
be used successfully in the management of bruxism & TMD
Bio Med Central Oral Health 2008. The NTI-tss device for
the therapy of bruxism, temporomandibular disorders and
headache – Where do we stand. A qualitative systematic
review of the literature.
Useful Websites:
Wikipedia
Nociceptive Trigeminal Inhibition-Tension Suppresion
System
Nociceptive Trigeminal Inhibition Tension Suppression
System - How Does It Work
The NTI appliance fits on top of the teeth and alters the
angle at which the jaw opens, by covering only the front
teeth and preventing the molars from coming into contact
with each other, thus limiting the contraction of the
temporalis muscle. When the grinding starts in the night,
the pressure which is applied to the incisors can, it is
claimed, send an alarm signal to the brain.
The NTI device must be fitted by a dentist.
The efficacy of such devices is debated. Some writers
propose that irreversible complications can result from the
long-term use of mouthguards and repositioning splints.
Useful Articles:
Evidence Based Dentistry 2009. The NTI-tss device may
be used successfully in the management of bruxism & TMD
Bio Med Central Oral Health 2008. The NTI-tss device for
the therapy of bruxism, temporomandibular disorders and
headache – Where do we stand. A qualitative systematic
review of the literature.
Useful Websites:
Wikipedia
Nociceptive Trigeminal Inhibition-Tension Suppresion
System
Nociceptive Trigeminal Inhibition Tension Suppression
System - How Does It Work
| Nociceptive Trigeminal Inhibitor-Tension Suppression System Appliance (NTI-tss) Appliance |
| Nociceptive Trigeminal Inhibitor-Tension Suppression System Appliance (NTI-tss) Appliance being worn |
Bio-Feedback
Various bio-feedback devices are currently available and
effectiveness varies significantly depending on whether the
bio-feedback is used only during waking hours or during
sleep as well.
Many authorities remain unconvinced of the efficacy of
'daytime-only' bio-feedback.
The efficacy of bio-feedback delivered during sleep can
depend strongly on daytime training, which is used to
establish a Pavlovian response to the bio-feedback signal
that persists during sleep.
Useful Websites:
GrindAlert by BruxCare
SleepGuard
GrindCare
Taste Bio-Feedback
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) aims to help the
patient to manage their problems by changing how they
think and act.
CBT encourages the patient to talk about:
By talking about these things, CBT can help the patient to
change how the patient thinks (‘cognitive’) and what the
patient does (‘behaviour’), which can help the patient feel
better about life.
Useful Websites:
Wikipedia
Royal College of Psychiatrists
NHS Choices
Patient UK
Botox
Botulinum toxin (Botox) can be successful in lessening
effects of bruxism.
Bruxism can also be regarded as a disorder of repetitive,
unconscious contraction of the masseter muscle (the large
muscle that moves the jaw). In the treatment of bruxism,
Botox works to weaken the muscle enough to reduce the
effects of grinding and clenching but not so much as to
prevent proper use of the muscle. Injections must be
repeated more than once per year.
The symptoms that can be helped by this procedure
include:
The effects last for about three months. The muscles
wither (atrophy), however, so after a few rounds of
treatment, it is usually possible either to decrease the
dose or increase the interval between treatments.
Other authorities caution that Botox should only be used
for temporary relief for severe cases and should be
followed by diagnosis and treatment to prevent future
bruxism or jaw clenching, suggesting that prolonged use of
Botox can lead to permanent damage to the jaw muscle.
Useful Website:
The Daily Mail, March 2009 - How to stop teeth-grinding ...
with a little help from Botox
Dietary Supplements
There is anecdotal evidence that suggests taking certain
combinations of dietary supplements may alleviate
bruxism; pantothenic acid, magnesium and calcium are
mentioned on dietary supplement websites.
Calcium is known to be a treatment for gastric problems,
and gastric problems such as acid reflux are known to
increase bruxism. Placing whole cloves at night inside the
mouth is suggested to have an effect on the jaw's muscle
by relaxing it, yet evidence of this remains largely
anecdotal without future research.
Useful Articles:
American Dental Association 2005. Do You Grind Your
Teeth?
Cochrane Database of Systematic Reviews 2008.
Occlusal splints for treating sleep bruxism (tooth grinding)
Vital Summer 2011. Raising awareness of bruxism
American Academy of Oral Medicine 2008. Patient
Information Sheet. Tooth Clenching or Grinding
Useful Websites:
Wikipedia
WebMD
The Bruxism Association
Bruxism (Teeth Clenching or Grinding) Advice, Links,
Resources
MedicineNet.com
BBC News - Why are we grinding our teeth so much?
BBC Case Notes – The Jaw (also covers bruxism)
Health-Cares.net
Bruxism Ireland
The Times, March 2009 - Q&A: How to deal with grinding
teeth.
Teeth Grinding Forum
NHS Choices - Teeth Grinding (Grinding)
Various bio-feedback devices are currently available and
effectiveness varies significantly depending on whether the
bio-feedback is used only during waking hours or during
sleep as well.
Many authorities remain unconvinced of the efficacy of
'daytime-only' bio-feedback.
The efficacy of bio-feedback delivered during sleep can
depend strongly on daytime training, which is used to
establish a Pavlovian response to the bio-feedback signal
that persists during sleep.
Useful Websites:
GrindAlert by BruxCare
SleepGuard
GrindCare
Taste Bio-Feedback
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) aims to help the
patient to manage their problems by changing how they
think and act.
CBT encourages the patient to talk about:
- how they think about themselves, the world and other
people - how what the patient does affects their thoughts and
feelings
By talking about these things, CBT can help the patient to
change how the patient thinks (‘cognitive’) and what the
patient does (‘behaviour’), which can help the patient feel
better about life.
Useful Websites:
Wikipedia
Royal College of Psychiatrists
NHS Choices
Patient UK
Botox
Botulinum toxin (Botox) can be successful in lessening
effects of bruxism.
Bruxism can also be regarded as a disorder of repetitive,
unconscious contraction of the masseter muscle (the large
muscle that moves the jaw). In the treatment of bruxism,
Botox works to weaken the muscle enough to reduce the
effects of grinding and clenching but not so much as to
prevent proper use of the muscle. Injections must be
repeated more than once per year.
The symptoms that can be helped by this procedure
include:
- Grinding and clenching
- Morning jaw soreness
- TMJ pain
- Muscle tension throughout the day
- Migraines triggered by clenching
- Neck pain and stiffness triggered by clenching
The effects last for about three months. The muscles
wither (atrophy), however, so after a few rounds of
treatment, it is usually possible either to decrease the
dose or increase the interval between treatments.
Other authorities caution that Botox should only be used
for temporary relief for severe cases and should be
followed by diagnosis and treatment to prevent future
bruxism or jaw clenching, suggesting that prolonged use of
Botox can lead to permanent damage to the jaw muscle.
Useful Website:
The Daily Mail, March 2009 - How to stop teeth-grinding ...
with a little help from Botox
Dietary Supplements
There is anecdotal evidence that suggests taking certain
combinations of dietary supplements may alleviate
bruxism; pantothenic acid, magnesium and calcium are
mentioned on dietary supplement websites.
Calcium is known to be a treatment for gastric problems,
and gastric problems such as acid reflux are known to
increase bruxism. Placing whole cloves at night inside the
mouth is suggested to have an effect on the jaw's muscle
by relaxing it, yet evidence of this remains largely
anecdotal without future research.
Useful Articles:
American Dental Association 2005. Do You Grind Your
Teeth?
Cochrane Database of Systematic Reviews 2008.
Occlusal splints for treating sleep bruxism (tooth grinding)
Vital Summer 2011. Raising awareness of bruxism
American Academy of Oral Medicine 2008. Patient
Information Sheet. Tooth Clenching or Grinding
Useful Websites:
Wikipedia
WebMD
The Bruxism Association
Bruxism (Teeth Clenching or Grinding) Advice, Links,
Resources
MedicineNet.com
BBC News - Why are we grinding our teeth so much?
BBC Case Notes – The Jaw (also covers bruxism)
Health-Cares.net
Bruxism Ireland
The Times, March 2009 - Q&A: How to deal with grinding
teeth.
Teeth Grinding Forum
NHS Choices - Teeth Grinding (Grinding)
| Photos of Habit Breakers (my thanks to Derek Lucas for these photos) |
| Last Updated 1st November 2011 |
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